Could Menthol Cigarettes Pose Even Higher Stroke Risk?

For women and whites, the odds look even worse, study finds.

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MONDAY, April 9, 2012 (HealthDay News) —
Menthol cigarettes may pose an even greater risk for stroke
than other types of cigarettes, especially for women and non-black smokers,
says a new, large study.

In the latest look at the hazards of menthols
vs. regular cigarettes, Canadian researchers found the stroke risk for those
who smoked menthols was more than twice that for regular-cigarette smokers. And
for women and non-blacks, the risk was more than three times higher.

But no elevated risk was seen between mentholated cigarette smoking
and high blood pressure, heart attack, heart failure and the lung disease chronic
obstructive pulmonary disease (COPD), the researchers said.

Exactly how, or if, smoking menthol cigarettes raises risk of
stroke more than other cigarettes types is not fully understood.

"One potential mechanism is that menthol stimulates
upper-airway cold receptors, which can increase breath-holding time, which may
in turn facilitate the entrance of cigarette particulate matter into the
lungs," said study author Dr. Nicholas Vozoris of St. Michael's Hospital,
in Toronto. "Why smoking mentholated cigarettes would not result in an
increase in forms of cardiopulmonary disease, other than stroke, is not
clear."

The findings appear in a research letter published April 9 in the Archives
of Internal Medicine.

Blacks are more likely to smoke menthol cigarettes than white
smokers, but their stroke risk was lower in this study compared to non-blacks.
"While this group has higher risk for stroke than Caucasians in general,
this study found that the increased stroke risk among mentholated cigarette
smokers was actually driven by non-African Americans, and not
African-Americans," he said.

The findings should not be interpreted as any one type of cigarette
is safer than any other. "There is no 'good' cigarette type," Vozoris
said. "Smoking any kind of cigarette is bad for one's health, and serves
to increase one's risk for a variety of cancers, heart diseases and lung
diseases. However, this study shows that smoking mentholated cigarettes may
place one at even higher risk for stroke than smoking regular, non-mentholated
cigarettes."

To date, research on menthol cigarettes has been inconclusive. Last
year, a U.S. Food and Drug Administration advisory panel said a ban on
mentholated cigarettes might benefit the public health because the minty flavor
seems to help people take up smoking more readily. However, the panel did not
conclude that menthols were more harmful than regular cigarettes in terms of
risks for lung cancer or other respiratory ailments.

Shortly after that recommendation was made, a study published in
the Journal of the National Cancer Institute reported
that people who smoke menthol cigarettes might even have a somewhat lower risk
of developing and dying from lung
cancer than other smokers.

For this new study, the researchers used data from the 2001-2008
U.S. National Health and Nutrition Examination Surveys on more than 5,000
smokers age 20 and older. About 26 percent said they usually smoked menthols.

The researchers found that stroke risk associated with smoking
menthols was 2.25 times higher compared to regular smokers; 3.28 times higher
for women, and 3.48 times higher for non-blacks.

However, Vozoris said the new study has several limitations. The
researchers didn't account for drug treatment that might have affected the
findings, and the smoking habits were self-reported. Also, former smokers
weren't included in the data.

Dr. Clinton Wright, an associate professor of neurology at the
University of Miami Miller School of Medicine, said that more study is needed
before any conclusions can be drawn about specific health risks associated with
specific types of cigarettes. "Very little work has been done on mentholated
cigarettes," he said.

Also, the new study "only shows an association, it does not
show any cause and effect," he added.

Still, "mentholation may have chemicals involved in the
process that may carry their own risks," he said. As to the finding that
this elevated stroke risk was driven by whites, Wright said that the study may
not have had enough blacks to pick up on a higher risk in this group.

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